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ZevaHermanMD
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| Communities: Breast Cancer | Thank You's: 2 |
| Member Since: Nov. 2011 | Questions: 0 |
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Professional Statement
Dr. Zeva Herman is a graduate of the Sophie Davis School of Biomedical Education, a 6 yr accelerated BS-MD program at CCNY. She received her MD from Mount Sinai School of Medicine.
Following Medical School, Dr. Herman completed a Medical Internship and Radiology Residency at Lenox Hill Hospital, where she was Chief Resident. She completed a year of Fellowship training at Memorial Sloan Kettering Cancer Center.
Dr. Herman held the position of Assistant Clinical Professor of Radiology at Mount Sinai Hospital from 2000-2004 and has been in private practice in NYC where she specializes in breast imaging and interventional breast procedures.
Dr. Herman is Board Certified by the American Board of Radiology. She is a member, and Past President of The NY Breast Imaging Society. She is a member of the Metropolitan Breast Cancer Group, The American Roentgen Ray Society, Radiologic Society of North America, and the NY Roentgen Society. Dr. Herman has published and spoken on various breast imaging topics.
Following Medical School, Dr. Herman completed a Medical Internship and Radiology Residency at Lenox Hill Hospital, where she was Chief Resident. She completed a year of Fellowship training at Memorial Sloan Kettering Cancer Center.
Dr. Herman held the position of Assistant Clinical Professor of Radiology at Mount Sinai Hospital from 2000-2004 and has been in private practice in NYC where she specializes in breast imaging and interventional breast procedures.
Dr. Herman is Board Certified by the American Board of Radiology. She is a member, and Past President of The NY Breast Imaging Society. She is a member of the Metropolitan Breast Cancer Group, The American Roentgen Ray Society, Radiologic Society of North America, and the NY Roentgen Society. Dr. Herman has published and spoken on various breast imaging topics.
Professional Info
Credential:
MD
Primary specialty:
Radiology
Gender: Female
Medical school:
Mount Sinai School of Medicine
Residency:
Lenox Hill Hospital
Internship:
Memorial Sloan Kettering
Board certifications:
American Board of Radiology
Professional memberships:
The NY Breast Imaging Society, Metropolitan Breast Cancer Group, The American Roentgen Ray Society, Radiologic Society of North America, NY Roentgen Society
Areas of expertise:
Breast imaging
Interventional breast procedures
Interventional breast procedures
Research interests:
Breast imaging
Practice name:
Park Avenue Radiologists
Practice address:
525 Park Avenue
New York, NY
10065
Practice phone number:
212-888-1000
ZevaHermanMD Activities
Microcalcifications on a mammogram are a very common finding. They appear as tiny white specks or granules, composed of the element calcium. Most calcifications on a mammogram are perfectly normal and we just include them in the catchall diagnosis of "fibrocystic changes". They are not related to your dietary intake of calcium and you may continue with any dietary calcium you take.
Because cancer can lay down calcium, as well, it is the job of the radiologist to differentiate between the normal, innocuous calcium and the worrisome calcium. When calcifications are punctate and "round and regular" they can be dismissed. Calcifications within cysts are also normal. Calcifications which are potentially of concern are clustered, and their morphology is pleomorphic, appearing brached or irregular in shape, size and density. Clustered calcifications which are not definitively benign will either be watched at 6 month intervals, or biopsied. The best mode of biopsy for mammographic calcifications is a Stereotactic guided vacuum-assisted core needle biopsy. This is a minimally invasive needle procedure performed by the radiologist, or in some instances by a surgeon, that takes 20-40 minutes.
Results of this evaluation commonly are: normal (I won't go into all of those pathologic entities), ADH (atypical ductal hyperplasia), DCIS (duct carcinoma in situ), or invasive ductal carcinoma (IDC). Other important entities such as papilloma and radial scar will not be discussed here.
ADH is atypical cells. That means the pathologist visualizes abnormal cells, but they do not fulfill the criteria of cancer. ADH is significant because women with this diagnosis have an increased risk of breast carcinoma compared with the general population (about 4 times normal). If ADH is identified on needle biopsy, an excisional (surgical) biopsy is required to further evaluate this area. The tissue in this area is removed in order to see if there is any additional disease which was not removed by the needle sampling, such as DCIS or IDC, and to remove the remaining ADH. Statistically most women with ADH will never develop an invasive cancer, but they must be watched carefully because of the increased risk. Tamoxifen, an anti-estrogen drug, may sometimes be an option to reduce risk of breast cancer in these patients.
DCIS (duct carinoma in situ) is an early caner, stage 0. It is not a pre-cancer, it is an early cancer. It refers to cancer cells which are confined within the [basement membrane of the] duct. If cancer cells break through the basement membrane, it is refered to as IDC, invasive duct carcinoma. If DCIS is identifed on needle biopsy is must be surgically removed. The patient's prognosis is excellent. There are different subcategories of DCIS, some more aggressive than others. A women diagnosed with DCIS has an increased risk of developing a second DCIS later, or an invasive carcinoma. Because DCIS is confined to the ducts it should never metastisize or spread to other organs (but we never say never in medicine). Newer studies are characterizing DCIS by protein markers or genetics to identify the more aggressive ones, which have higher risk of the patient developing an invasive cancer in the future. Medical treatments such as Tamoxifen can be considered. Mastectomy is indicated in a small number of cases including depending on the size of the DCIS and the family history. Your diagnosis of DCIS supercedes your diagnosis of ADH, so there is no reason to mention the ADH. Your diagnosis is DCIS.
Good luck, I am confident you will do fine! Microcalcifications on a mammogram are a very common finding. They appear as tiny white specks or granules, composed of the element calcium. Most calcifications on a mammogram are perfectly normal and we just include them in the catchall diagnosis of "fibrocystic changes". They are not related to your dietary intake of calcium and you may continue with any dietary calcium you take.
Because cancer can lay down calcium, as well, it is the job of the radiologist to differentiate between the normal, innocuous calcium and the worrisome calcium. When calcifications are punctate and "round and regular" they can be dismissed. Calcifications within cysts are also normal. Calcifications which are potentially of concern are clustered, and their morphology is pleomorphic, appearing brached or irregular in shape, size and density. Clustered calcifications which are not definitively benign will either be watched at 6 month intervals, or biopsied. The best mode of biopsy for mammographic calcifications is a Stereotactic guided vacuum-assisted core needle biopsy. This is a minimally invasive needle procedure performed by the radiologist, or in some instances by a surgeon, that takes 20-40 minutes.
Results of this evaluation commonly are: normal (I won't go into all of those pathologic entities), ADH (atypical ductal hyperplasia), DCIS (duct carcinoma in situ), or invasive ductal carcinoma (IDC). Other important entities such as papilloma and radial scar will not be discussed here.
ADH is atypical cells. That means the pathologist visualizes abnormal cells, but they do not fulfill the criteria of cancer. ADH is significant because women with this diagnosis have an increased risk of breast carcinoma compared with the general population (about 4 times normal). If ADH is identified on needle biopsy, an excisional (surgical) biopsy is required to further evaluate this area. The tissue in this area is removed in order to see if there is any additional disease which was not removed by the needle sampling, such as DCIS or IDC, and to remove the remaining ADH. Statistically most women with ADH will never develop an invasive cancer, but they must be watched carefully because of the increased risk. Tamoxifen, an anti-estrogen drug, may sometimes be an option to reduce risk of breast cancer in these patients.
DCIS (duct carinoma in situ) is an early caner, stage 0. It is not a pre-cancer, it is an early cancer. It refers to cancer cells which are confined within the [basement membrane of the] duct. If cancer cells break through the basement membrane, it is refered to as IDC, invasive duct carcinoma. If DCIS is identifed on needle biopsy is must be surgically removed. The patient's prognosis is excellent. There are different subcategories of DCIS, some more aggressive than others. A women diagnosed with DCIS has an increased risk of developing a second DCIS later, or an invasive carcinoma. Because DCIS is confined to the ducts it should never metastisize or spread to other organs (but we never say never in medicine). Newer studies are characterizing DCIS by protein markers or genetics to identify the more aggressive ones, which have higher risk of the patient developing an invasive cancer in the future. Medical treatments such as Tamoxifen can be considered. Mastectomy is indicated in a small number of cases including depending on the size of the DCIS and the family history. Your diagnosis of DCIS supercedes your diagnosis of ADH, so there is no reason to mention the ADH. Your diagnosis is DCIS.
Good luck, I am confident you will do fine!
Because cancer can lay down calcium, as well, it is the job of the radiologist to differentiate between the normal, innocuous calcium and the worrisome calcium. When calcifications are punctate and "round and regular" they can be dismissed. Calcifications within cysts are also normal. Calcifications which are potentially of concern are clustered, and their morphology is pleomorphic, appearing brached or irregular in shape, size and density. Clustered calcifications which are not definitively benign will either be watched at 6 month intervals, or biopsied. The best mode of biopsy for mammographic calcifications is a Stereotactic guided vacuum-assisted core needle biopsy. This is a minimally invasive needle procedure performed by the radiologist, or in some instances by a surgeon, that takes 20-40 minutes.
Results of this evaluation commonly are: normal (I won't go into all of those pathologic entities), ADH (atypical ductal hyperplasia), DCIS (duct carcinoma in situ), or invasive ductal carcinoma (IDC). Other important entities such as papilloma and radial scar will not be discussed here.
ADH is atypical cells. That means the pathologist visualizes abnormal cells, but they do not fulfill the criteria of cancer. ADH is significant because women with this diagnosis have an increased risk of breast carcinoma compared with the general population (about 4 times normal). If ADH is identified on needle biopsy, an excisional (surgical) biopsy is required to further evaluate this area. The tissue in this area is removed in order to see if there is any additional disease which was not removed by the needle sampling, such as DCIS or IDC, and to remove the remaining ADH. Statistically most women with ADH will never develop an invasive cancer, but they must be watched carefully because of the increased risk. Tamoxifen, an anti-estrogen drug, may sometimes be an option to reduce risk of breast cancer in these patients.
DCIS (duct carinoma in situ) is an early caner, stage 0. It is not a pre-cancer, it is an early cancer. It refers to cancer cells which are confined within the [basement membrane of the] duct. If cancer cells break through the basement membrane, it is refered to as IDC, invasive duct carcinoma. If DCIS is identifed on needle biopsy is must be surgically removed. The patient's prognosis is excellent. There are different subcategories of DCIS, some more aggressive than others. A women diagnosed with DCIS has an increased risk of developing a second DCIS later, or an invasive carcinoma. Because DCIS is confined to the ducts it should never metastisize or spread to other organs (but we never say never in medicine). Newer studies are characterizing DCIS by protein markers or genetics to identify the more aggressive ones, which have higher risk of the patient developing an invasive cancer in the future. Medical treatments such as Tamoxifen can be considered. Mastectomy is indicated in a small number of cases including depending on the size of the DCIS and the family history. Your diagnosis of DCIS supercedes your diagnosis of ADH, so there is no reason to mention the ADH. Your diagnosis is DCIS.
Good luck, I am confident you will do fine! Microcalcifications on a mammogram are a very common finding. They appear as tiny white specks or granules, composed of the element calcium. Most calcifications on a mammogram are perfectly normal and we just include them in the catchall diagnosis of "fibrocystic changes". They are not related to your dietary intake of calcium and you may continue with any dietary calcium you take.
Because cancer can lay down calcium, as well, it is the job of the radiologist to differentiate between the normal, innocuous calcium and the worrisome calcium. When calcifications are punctate and "round and regular" they can be dismissed. Calcifications within cysts are also normal. Calcifications which are potentially of concern are clustered, and their morphology is pleomorphic, appearing brached or irregular in shape, size and density. Clustered calcifications which are not definitively benign will either be watched at 6 month intervals, or biopsied. The best mode of biopsy for mammographic calcifications is a Stereotactic guided vacuum-assisted core needle biopsy. This is a minimally invasive needle procedure performed by the radiologist, or in some instances by a surgeon, that takes 20-40 minutes.
Results of this evaluation commonly are: normal (I won't go into all of those pathologic entities), ADH (atypical ductal hyperplasia), DCIS (duct carcinoma in situ), or invasive ductal carcinoma (IDC). Other important entities such as papilloma and radial scar will not be discussed here.
ADH is atypical cells. That means the pathologist visualizes abnormal cells, but they do not fulfill the criteria of cancer. ADH is significant because women with this diagnosis have an increased risk of breast carcinoma compared with the general population (about 4 times normal). If ADH is identified on needle biopsy, an excisional (surgical) biopsy is required to further evaluate this area. The tissue in this area is removed in order to see if there is any additional disease which was not removed by the needle sampling, such as DCIS or IDC, and to remove the remaining ADH. Statistically most women with ADH will never develop an invasive cancer, but they must be watched carefully because of the increased risk. Tamoxifen, an anti-estrogen drug, may sometimes be an option to reduce risk of breast cancer in these patients.
DCIS (duct carinoma in situ) is an early caner, stage 0. It is not a pre-cancer, it is an early cancer. It refers to cancer cells which are confined within the [basement membrane of the] duct. If cancer cells break through the basement membrane, it is refered to as IDC, invasive duct carcinoma. If DCIS is identifed on needle biopsy is must be surgically removed. The patient's prognosis is excellent. There are different subcategories of DCIS, some more aggressive than others. A women diagnosed with DCIS has an increased risk of developing a second DCIS later, or an invasive carcinoma. Because DCIS is confined to the ducts it should never metastisize or spread to other organs (but we never say never in medicine). Newer studies are characterizing DCIS by protein markers or genetics to identify the more aggressive ones, which have higher risk of the patient developing an invasive cancer in the future. Medical treatments such as Tamoxifen can be considered. Mastectomy is indicated in a small number of cases including depending on the size of the DCIS and the family history. Your diagnosis of DCIS supercedes your diagnosis of ADH, so there is no reason to mention the ADH. Your diagnosis is DCIS.
Good luck, I am confident you will do fine!
New answer by ZevaHermanMD (Physician - Radiology (Verified)) in topic(s) Stage 0 (DCIS) Breast Cancer, Atypical Hyperplasia, Breast Cancer, Micro-calcifications
1
Answer |
5 months ago
These are the guidelines:
For the general population, no family history of breast cancer:
Baseline mammogram at age 35 or 37. Mammograms every 1-2 years from 40-50, annual mammography above age 50.
I am sure that you are aware that there is a great deal of controversy regarding annual mammograms in the 40's. I believe that they should definitely be done. It is true that cancer is less common in this age group compared with women above 50, but unfortunatley we do see many cases in young women. Statistically, some argue that the mammograms are not reducing mortality, or saving lives. Well, in my opinion this is not the only criteria to measure, for example if you found an early cancer in a 46 year old women which will only require lumpectomy, but not mastectomy, or chemotherapy, (which might be the case had this only be diagnosed 4 years later), then we have done a great service to this patient and her quality of life. It is true that some of the cases diagnosed in the young women are particularly aggressive, and that the early detection may not save her life, but I do not think this is a reason for not offering it. Furthermore, some of the studies discouraging mammography discuss the anxiety related to additional workups (magnification views and spot views) and unnecessary biopsies, all valid arguments. But the anxiety can be allayed with proper discussions and education, and we are working on not biopsying findings that are not worrisome. But it is true that most biopsies are negative, still... we are doing our best with the technology we have, this may change in the future. I do not know the number of cancers I have identified in women under 50, on screening, but it is great! It is true that I have also biopsied many many benign nodules and calcifications, this is the trade-off.
In women with dense breasts and/or a family history of breast cancer, screening sonography should also be performed annually. Sonography may increase detection by 30% or so.
In women with a strong family history, or personal history of breast cancer, screening MRI should be performed, as well.
If both you and your mother have had premenopausal breast cancer, then genetic testing should probably be performed.
Good luck to you and your mom. These are the guidelines:
For the general population, no family history of breast cancer:
Baseline mammogram at age 35 or 37. Mammograms every 1-2 years from 40-50, annual mammography above age 50.
I am sure that you are aware that there is a great deal of controversy regarding annual mammograms in the 40's. I believe that they should definitely be done. It is true that cancer is less common in this age group compared with women above 50, but unfortunatley we do see many cases in young women. Statistically, some argue that the mammograms are not reducing mortality, or saving lives. Well, in my opinion this is not the only criteria to measure, for example if you found an early cancer in a 46 year old women which will only require lumpectomy, but not mastectomy, or chemotherapy, (which might be the case had this only be diagnosed 4 years later), then we have done a great service to this patient and her quality of life. It is true that some of the cases diagnosed in the young women are particularly aggressive, and that the early detection may not save her life, but I do not think this is a reason for not offering it. Furthermore, some of the studies discouraging mammography discuss the anxiety related to additional workups (magnification views and spot views) and unnecessary biopsies, all valid arguments. But the anxiety can be allayed with proper discussions and education, and we are working on not biopsying findings that are not worrisome. But it is true that most biopsies are negative, still... we are doing our best with the technology we have, this may change in the future. I do not know the number of cancers I have identified in women under 50, on screening, but it is great! It is true that I have also biopsied many many benign nodules and calcifications, this is the trade-off.
In women with dense breasts and/or a family history of breast cancer, screening sonography should also be performed annually. Sonography may increase detection by 30% or so.
In women with a strong family history, or personal history of breast cancer, screening MRI should be performed, as well.
If both you and your mother have had premenopausal breast cancer, then genetic testing should probably be performed.
Good luck to you and your mom.
For the general population, no family history of breast cancer:
Baseline mammogram at age 35 or 37. Mammograms every 1-2 years from 40-50, annual mammography above age 50.
I am sure that you are aware that there is a great deal of controversy regarding annual mammograms in the 40's. I believe that they should definitely be done. It is true that cancer is less common in this age group compared with women above 50, but unfortunatley we do see many cases in young women. Statistically, some argue that the mammograms are not reducing mortality, or saving lives. Well, in my opinion this is not the only criteria to measure, for example if you found an early cancer in a 46 year old women which will only require lumpectomy, but not mastectomy, or chemotherapy, (which might be the case had this only be diagnosed 4 years later), then we have done a great service to this patient and her quality of life. It is true that some of the cases diagnosed in the young women are particularly aggressive, and that the early detection may not save her life, but I do not think this is a reason for not offering it. Furthermore, some of the studies discouraging mammography discuss the anxiety related to additional workups (magnification views and spot views) and unnecessary biopsies, all valid arguments. But the anxiety can be allayed with proper discussions and education, and we are working on not biopsying findings that are not worrisome. But it is true that most biopsies are negative, still... we are doing our best with the technology we have, this may change in the future. I do not know the number of cancers I have identified in women under 50, on screening, but it is great! It is true that I have also biopsied many many benign nodules and calcifications, this is the trade-off.
In women with dense breasts and/or a family history of breast cancer, screening sonography should also be performed annually. Sonography may increase detection by 30% or so.
In women with a strong family history, or personal history of breast cancer, screening MRI should be performed, as well.
If both you and your mother have had premenopausal breast cancer, then genetic testing should probably be performed.
Good luck to you and your mom. These are the guidelines:
For the general population, no family history of breast cancer:
Baseline mammogram at age 35 or 37. Mammograms every 1-2 years from 40-50, annual mammography above age 50.
I am sure that you are aware that there is a great deal of controversy regarding annual mammograms in the 40's. I believe that they should definitely be done. It is true that cancer is less common in this age group compared with women above 50, but unfortunatley we do see many cases in young women. Statistically, some argue that the mammograms are not reducing mortality, or saving lives. Well, in my opinion this is not the only criteria to measure, for example if you found an early cancer in a 46 year old women which will only require lumpectomy, but not mastectomy, or chemotherapy, (which might be the case had this only be diagnosed 4 years later), then we have done a great service to this patient and her quality of life. It is true that some of the cases diagnosed in the young women are particularly aggressive, and that the early detection may not save her life, but I do not think this is a reason for not offering it. Furthermore, some of the studies discouraging mammography discuss the anxiety related to additional workups (magnification views and spot views) and unnecessary biopsies, all valid arguments. But the anxiety can be allayed with proper discussions and education, and we are working on not biopsying findings that are not worrisome. But it is true that most biopsies are negative, still... we are doing our best with the technology we have, this may change in the future. I do not know the number of cancers I have identified in women under 50, on screening, but it is great! It is true that I have also biopsied many many benign nodules and calcifications, this is the trade-off.
In women with dense breasts and/or a family history of breast cancer, screening sonography should also be performed annually. Sonography may increase detection by 30% or so.
In women with a strong family history, or personal history of breast cancer, screening MRI should be performed, as well.
If both you and your mother have had premenopausal breast cancer, then genetic testing should probably be performed.
Good luck to you and your mom.
New answer by ZevaHermanMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer Screening Guidelines, Breast Cancer Screening, Breast Cancer, Breast Cancer Risk, Breast Cancer Screening Recommendations
1
Answer |
5 months ago
A stereotactic biopsy is a form of needle biopsy. "Stereotactic" refers to method in which we will image the finding, in order to guide the needle. A stereotactic biopsy is the way we biopsy a mammogram finding, it is not used for ultrasound or MRI findings. If the finding is a cluster of calcifications found on mammography, this will be the preferable mode of biopsy. Nodules are often seen both on mammography and sonography and then an ultrasound guided biopsy is faster, cheaper, and more comfortable for the patient. When we refer to a stereotactic biopsy most facilities are using a vacuum-assisted devise (needle) but this is not part of the definition of stereotactic. A vacuum-assisted devise is particularly beneficial when sampling calcifications, as quantity of tissue retrieved will contribute to accuracy of the diagnosis. This is not necessarily the case for masses.
A stereotactic biopsy is a form of needle biopsy. "Stereotactic" refers to method in which we will image the finding, in order to guide the needle. A stereotactic biopsy is the way we biopsy a mammogram finding, it is not used for ultrasound or MRI findings. If the finding is a cluster of calcifications found on mammography, this will be the preferable mode of biopsy. Nodules are often seen both on mammography and sonography and then an ultrasound guided biopsy is faster, cheaper, and more comfortable for the patient. When we refer to a stereotactic biopsy most facilities are using a vacuum-assisted devise (needle) but this is not part of the definition of stereotactic. A vacuum-assisted devise is particularly beneficial when sampling calcifications, as quantity of tissue retrieved will contribute to accuracy of the diagnosis. This is not necessarily the case for masses.
New answer by ZevaHermanMD (Physician - Radiology (Verified)) in topic(s) Biopsy, Stereotactic Biopsy, Needle Biopsy, Procedures, Diagnosis
1
Answer |
5 months ago
Both conventional (analog) and digital mammograms are still in use, but in major cities most facilities that do a lot of mammograms (and state-of-the-art imaging) have switched to digital. Similar to you photos at home, there is a great deal of benefit to being able to post-process or adjust the images for better contrast, magnification, etc. Also viewing on a computer moniter is beneficial. That being said, a large scale study was performed by Dr. Etta Pisano when digital first came out. The study determined that digital mammograms will benefit women with dense breast tissue, and those who are under age 40. So, if you are not in these categories then it is OK to get an analog study.
My personal opinion, yes, digital mammograms are the norm for NYC, where I practice. Both conventional (analog) and digital mammograms are still in use, but in major cities most facilities that do a lot of mammograms (and state-of-the-art imaging) have switched to digital. Similar to you photos at home, there is a great deal of benefit to being able to post-process or adjust the images for better contrast, magnification, etc. Also viewing on a computer moniter is beneficial. That being said, a large scale study was performed by Dr. Etta Pisano when digital first came out. The study determined that digital mammograms will benefit women with dense breast tissue, and those who are under age 40. So, if you are not in these categories then it is OK to get an analog study.
My personal opinion, yes, digital mammograms are the norm for NYC, where I practice.
My personal opinion, yes, digital mammograms are the norm for NYC, where I practice. Both conventional (analog) and digital mammograms are still in use, but in major cities most facilities that do a lot of mammograms (and state-of-the-art imaging) have switched to digital. Similar to you photos at home, there is a great deal of benefit to being able to post-process or adjust the images for better contrast, magnification, etc. Also viewing on a computer moniter is beneficial. That being said, a large scale study was performed by Dr. Etta Pisano when digital first came out. The study determined that digital mammograms will benefit women with dense breast tissue, and those who are under age 40. So, if you are not in these categories then it is OK to get an analog study.
My personal opinion, yes, digital mammograms are the norm for NYC, where I practice.
New answer by ZevaHermanMD (Physician - Radiology (Verified)) in topic(s) Digital Mammograms, Breast Cancer Screening, Film Mammograms, Radiology, Mammograms
1
Answer |
5 months ago
For almost all findings found by imaging (mammography, sonography, or MRI) a needle biopsy is the preferred next step. Firstly, most of the findings (nodules and calcifications) which we identify are benign, so surgery can be avoided. Sometimes we are quite certain that the finding is malignant but still a needle biopsy is performed so that the surgeon performs surgery knowing what s/he is going after. For example, if the surgery is removal of a biopsy-proven cancer (lumpectomy) then they should remove larger margins. In this day and age it is fairly unusual to go to surgery to remove a nodule that the surgeon does not know what it is. Furthermore, if the diagnosis of cancer has been established in advance, then the surgeon will do the evaluation of axillary lymph nodes (sentinal node biopsy) at the time of the initial surgery (a one-step procedure). Also, they will be planning for the best cosmetic result.
When a lump is felt, but no abnormality is identified on imaging studies, a surgeon may still opt to remove it. In that scenario s/he does not know what they will find at surgery. A needle biopsy may or may not be done first. If a needle biopsy is being done, it is based on the palpable finding (feeling the lump) this would be done by the surgeon, not the radiologist. For almost all findings found by imaging (mammography, sonography, or MRI) a needle biopsy is the preferred next step. Firstly, most of the findings (nodules and calcifications) which we identify are benign, so surgery can be avoided. Sometimes we are quite certain that the finding is malignant but still a needle biopsy is performed so that the surgeon performs surgery knowing what s/he is going after. For example, if the surgery is removal of a biopsy-proven cancer (lumpectomy) then they should remove larger margins. In this day and age it is fairly unusual to go to surgery to remove a nodule that the surgeon does not know what it is. Furthermore, if the diagnosis of cancer has been established in advance, then the surgeon will do the evaluation of axillary lymph nodes (sentinal node biopsy) at the time of the initial surgery (a one-step procedure). Also, they will be planning for the best cosmetic result.
When a lump is felt, but no abnormality is identified on imaging studies, a surgeon may still opt to remove it. In that scenario s/he does not know what they will find at surgery. A needle biopsy may or may not be done first. If a needle biopsy is being done, it is based on the palpable finding (feeling the lump) this would be done by the surgeon, not the radiologist.
When a lump is felt, but no abnormality is identified on imaging studies, a surgeon may still opt to remove it. In that scenario s/he does not know what they will find at surgery. A needle biopsy may or may not be done first. If a needle biopsy is being done, it is based on the palpable finding (feeling the lump) this would be done by the surgeon, not the radiologist. For almost all findings found by imaging (mammography, sonography, or MRI) a needle biopsy is the preferred next step. Firstly, most of the findings (nodules and calcifications) which we identify are benign, so surgery can be avoided. Sometimes we are quite certain that the finding is malignant but still a needle biopsy is performed so that the surgeon performs surgery knowing what s/he is going after. For example, if the surgery is removal of a biopsy-proven cancer (lumpectomy) then they should remove larger margins. In this day and age it is fairly unusual to go to surgery to remove a nodule that the surgeon does not know what it is. Furthermore, if the diagnosis of cancer has been established in advance, then the surgeon will do the evaluation of axillary lymph nodes (sentinal node biopsy) at the time of the initial surgery (a one-step procedure). Also, they will be planning for the best cosmetic result.
When a lump is felt, but no abnormality is identified on imaging studies, a surgeon may still opt to remove it. In that scenario s/he does not know what they will find at surgery. A needle biopsy may or may not be done first. If a needle biopsy is being done, it is based on the palpable finding (feeling the lump) this would be done by the surgeon, not the radiologist.
New answer by ZevaHermanMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer, Needle Biopsy, Procedures, Surgical Biopsy, Breast Cancer Procedures, Breast Cancer Diagnosis
1
Answer |
5 months ago
BI-RADS stands for Breast Imaging Reporting and Data System. The American College of Radiology, AMA, and other medical organizations have agreed upon a reporting system that standardizes how radiologists describe findings on a mammogram, and more importatly how they make their recommendations so that the recommendation is clear, for the referring physician.
BI-RADS-1: NEGATIVE
This means no findings, nothing on which to comment.
BIRADS-2: BENIGN FINDINGS
This means that there is a normal finding such as a cyst or coarse (benign) calcification. No further intervention is indicated.
BIRADS-3: PROBABLY BENIGN FINDING, SHORT INTERVAL FOLLOW-UP IS SUGGESTED
This is used when there is finding that is most likely benign, but the radiologist cannot say so for certain. A radiologist will only use this category when they believe the finding has less than 2% risk of malignany. This may be used for example, for something such as a lymph node, which has a characteristic appearance and location, but is not definitvely fulfillling criteria of such. Or for calcifications that look very benign, but this is the first time they are appearing. The six month follow-up is to establish stability. The radiologist does not expect this finding to change during the follow-up interval.
Unfortunately, some gynecologists and patients have a hard time accepting this category. They think "what does the radiologist mean by "probably" it does not sound very scientific," but indeed it is the official term of the BIRADS lexicon. Some patients will push for a biopsy of a finding in this category, it is technically an option, but usually overkill. If radiologists recommended biopsy on all of these "probably benign" findings we would really be doing a disservice and an inordinant number of biopsies on benign entities.
BIRADS-4: SUSPICIOUS FINDING, BIOPSY SHOULD BE CONSIDERED
This is used for a finding that is not definitively benign and requires biopsy. This includes lesions that the radiologist believes are likely to be benign, such as fibroadenomas, as well as cancers. To differentiate, some people divide this category into 4A and 4B, low degree of suspicion and higher degree of suspicion. If your report has this category you can ask your doctor to elaborate if the findings has features highly suggestive of cancer, or not. The radiologist usually knows. Statistically, most nodules in this category turn out to be benign (fibroadenomas).
BIRADS-5: HIGHLY SUGGESTIVE OF MALIGNANCY-APPROPRIATE ACTION SHOULD BE TAKEN
These lesions have a high probablility (greater than 95%) of being cancer. Honestly, many radiologists do not use this category since BIRADS4 is already recommending biopsy. But it is true that often a finding is so characteristic that the radiologist knows it is cancer, but still nothing gets treated without a biopsy first.
BIRADS-6: KNOWN MALIGNANCY
This is used when the patient has a biopsy proven cancer, but additional imaging is still needed. A common scenario of this, is the MRI that is done when cancer has been diagnosed but we are looking if there are any additional sites of cancer (extent of disease work-up).
BIRADS-O: NEEDS ADDITIONAL IMAGING (OR OLD FILMS)
This is basicaly saying that the work-up is incomplete and a final interpretation cannot be given. This is used in a screening situation. In most facilities four images are taken by the technologist and the radiologist interprets the study at a later time. If there is a finding, the radiologist will often require additional views (compression spot views or magnification views) to clarify the finding. The patient will be notified that they need to return to the radiology office. Statistically, most of these call backs will be normal, the patient will not end up having any abnormality or require biopsy. In a small percentage, a biopsy might be ordered, but most of these will still turn out to be benign. BI-RADS stands for Breast Imaging Reporting and Data System. The American College of Radiology, AMA, and other medical organizations have agreed upon a reporting system that standardizes how radiologists describe findings on a mammogram, and more importatly how they make their recommendations so that the recommendation is clear, for the referring physician.
BI-RADS-1: NEGATIVE
This means no findings, nothing on which to comment.
BIRADS-2: BENIGN FINDINGS
This means that there is a normal finding such as a cyst or coarse (benign) calcification. No further intervention is indicated.
BIRADS-3: PROBABLY BENIGN FINDING, SHORT INTERVAL FOLLOW-UP IS SUGGESTED
This is used when there is finding that is most likely benign, but the radiologist cannot say so for certain. A radiologist will only use this category when they believe the finding has less than 2% risk of malignany. This may be used for example, for something such as a lymph node, which has a characteristic appearance and location, but is not definitvely fulfillling criteria of such. Or for calcifications that look very benign, but this is the first time they are appearing. The six month follow-up is to establish stability. The radiologist does not expect this finding to change during the follow-up interval.
Unfortunately, some gynecologists and patients have a hard time accepting this category. They think "what does the radiologist mean by "probably" it does not sound very scientific," but indeed it is the official term of the BIRADS lexicon. Some patients will push for a biopsy of a finding in this category, it is technically an option, but usually overkill. If radiologists recommended biopsy on all of these "probably benign" findings we would really be doing a disservice and an inordinant number of biopsies on benign entities.
BIRADS-4: SUSPICIOUS FINDING, BIOPSY SHOULD BE CONSIDERED
This is used for a finding that is not definitively benign and requires biopsy. This includes lesions that the radiologist believes are likely to be benign, such as fibroadenomas, as well as cancers. To differentiate, some people divide this category into 4A and 4B, low degree of suspicion and higher degree of suspicion. If your report has this category you can ask your doctor to elaborate if the findings has features highly suggestive of cancer, or not. The radiologist usually knows. Statistically, most nodules in this category turn out to be benign (fibroadenomas).
BIRADS-5: HIGHLY SUGGESTIVE OF MALIGNANCY-APPROPRIATE ACTION SHOULD BE TAKEN
These lesions have a high probablility (greater than 95%) of being cancer. Honestly, many radiologists do not use this category since BIRADS4 is already recommending biopsy. But it is true that often a finding is so characteristic that the radiologist knows it is cancer, but still nothing gets treated without a biopsy first.
BIRADS-6: KNOWN MALIGNANCY
This is used when the patient has a biopsy proven cancer, but additional imaging is still needed. A common scenario of this, is the MRI that is done when cancer has been diagnosed but we are looking if there are any additional sites of cancer (extent of disease work-up).
BIRADS-O: NEEDS ADDITIONAL IMAGING (OR OLD FILMS)
This is basicaly saying that the work-up is incomplete and a final interpretation cannot be given. This is used in a screening situation. In most facilities four images are taken by the technologist and the radiologist interprets the study at a later time. If there is a finding, the radiologist will often require additional views (compression spot views or magnification views) to clarify the finding. The patient will be notified that they need to return to the radiology office. Statistically, most of these call backs will be normal, the patient will not end up having any abnormality or require biopsy. In a small percentage, a biopsy might be ordered, but most of these will still turn out to be benign.
BI-RADS-1: NEGATIVE
This means no findings, nothing on which to comment.
BIRADS-2: BENIGN FINDINGS
This means that there is a normal finding such as a cyst or coarse (benign) calcification. No further intervention is indicated.
BIRADS-3: PROBABLY BENIGN FINDING, SHORT INTERVAL FOLLOW-UP IS SUGGESTED
This is used when there is finding that is most likely benign, but the radiologist cannot say so for certain. A radiologist will only use this category when they believe the finding has less than 2% risk of malignany. This may be used for example, for something such as a lymph node, which has a characteristic appearance and location, but is not definitvely fulfillling criteria of such. Or for calcifications that look very benign, but this is the first time they are appearing. The six month follow-up is to establish stability. The radiologist does not expect this finding to change during the follow-up interval.
Unfortunately, some gynecologists and patients have a hard time accepting this category. They think "what does the radiologist mean by "probably" it does not sound very scientific," but indeed it is the official term of the BIRADS lexicon. Some patients will push for a biopsy of a finding in this category, it is technically an option, but usually overkill. If radiologists recommended biopsy on all of these "probably benign" findings we would really be doing a disservice and an inordinant number of biopsies on benign entities.
BIRADS-4: SUSPICIOUS FINDING, BIOPSY SHOULD BE CONSIDERED
This is used for a finding that is not definitively benign and requires biopsy. This includes lesions that the radiologist believes are likely to be benign, such as fibroadenomas, as well as cancers. To differentiate, some people divide this category into 4A and 4B, low degree of suspicion and higher degree of suspicion. If your report has this category you can ask your doctor to elaborate if the findings has features highly suggestive of cancer, or not. The radiologist usually knows. Statistically, most nodules in this category turn out to be benign (fibroadenomas).
BIRADS-5: HIGHLY SUGGESTIVE OF MALIGNANCY-APPROPRIATE ACTION SHOULD BE TAKEN
These lesions have a high probablility (greater than 95%) of being cancer. Honestly, many radiologists do not use this category since BIRADS4 is already recommending biopsy. But it is true that often a finding is so characteristic that the radiologist knows it is cancer, but still nothing gets treated without a biopsy first.
BIRADS-6: KNOWN MALIGNANCY
This is used when the patient has a biopsy proven cancer, but additional imaging is still needed. A common scenario of this, is the MRI that is done when cancer has been diagnosed but we are looking if there are any additional sites of cancer (extent of disease work-up).
BIRADS-O: NEEDS ADDITIONAL IMAGING (OR OLD FILMS)
This is basicaly saying that the work-up is incomplete and a final interpretation cannot be given. This is used in a screening situation. In most facilities four images are taken by the technologist and the radiologist interprets the study at a later time. If there is a finding, the radiologist will often require additional views (compression spot views or magnification views) to clarify the finding. The patient will be notified that they need to return to the radiology office. Statistically, most of these call backs will be normal, the patient will not end up having any abnormality or require biopsy. In a small percentage, a biopsy might be ordered, but most of these will still turn out to be benign. BI-RADS stands for Breast Imaging Reporting and Data System. The American College of Radiology, AMA, and other medical organizations have agreed upon a reporting system that standardizes how radiologists describe findings on a mammogram, and more importatly how they make their recommendations so that the recommendation is clear, for the referring physician.
BI-RADS-1: NEGATIVE
This means no findings, nothing on which to comment.
BIRADS-2: BENIGN FINDINGS
This means that there is a normal finding such as a cyst or coarse (benign) calcification. No further intervention is indicated.
BIRADS-3: PROBABLY BENIGN FINDING, SHORT INTERVAL FOLLOW-UP IS SUGGESTED
This is used when there is finding that is most likely benign, but the radiologist cannot say so for certain. A radiologist will only use this category when they believe the finding has less than 2% risk of malignany. This may be used for example, for something such as a lymph node, which has a characteristic appearance and location, but is not definitvely fulfillling criteria of such. Or for calcifications that look very benign, but this is the first time they are appearing. The six month follow-up is to establish stability. The radiologist does not expect this finding to change during the follow-up interval.
Unfortunately, some gynecologists and patients have a hard time accepting this category. They think "what does the radiologist mean by "probably" it does not sound very scientific," but indeed it is the official term of the BIRADS lexicon. Some patients will push for a biopsy of a finding in this category, it is technically an option, but usually overkill. If radiologists recommended biopsy on all of these "probably benign" findings we would really be doing a disservice and an inordinant number of biopsies on benign entities.
BIRADS-4: SUSPICIOUS FINDING, BIOPSY SHOULD BE CONSIDERED
This is used for a finding that is not definitively benign and requires biopsy. This includes lesions that the radiologist believes are likely to be benign, such as fibroadenomas, as well as cancers. To differentiate, some people divide this category into 4A and 4B, low degree of suspicion and higher degree of suspicion. If your report has this category you can ask your doctor to elaborate if the findings has features highly suggestive of cancer, or not. The radiologist usually knows. Statistically, most nodules in this category turn out to be benign (fibroadenomas).
BIRADS-5: HIGHLY SUGGESTIVE OF MALIGNANCY-APPROPRIATE ACTION SHOULD BE TAKEN
These lesions have a high probablility (greater than 95%) of being cancer. Honestly, many radiologists do not use this category since BIRADS4 is already recommending biopsy. But it is true that often a finding is so characteristic that the radiologist knows it is cancer, but still nothing gets treated without a biopsy first.
BIRADS-6: KNOWN MALIGNANCY
This is used when the patient has a biopsy proven cancer, but additional imaging is still needed. A common scenario of this, is the MRI that is done when cancer has been diagnosed but we are looking if there are any additional sites of cancer (extent of disease work-up).
BIRADS-O: NEEDS ADDITIONAL IMAGING (OR OLD FILMS)
This is basicaly saying that the work-up is incomplete and a final interpretation cannot be given. This is used in a screening situation. In most facilities four images are taken by the technologist and the radiologist interprets the study at a later time. If there is a finding, the radiologist will often require additional views (compression spot views or magnification views) to clarify the finding. The patient will be notified that they need to return to the radiology office. Statistically, most of these call backs will be normal, the patient will not end up having any abnormality or require biopsy. In a small percentage, a biopsy might be ordered, but most of these will still turn out to be benign.
New answer by ZevaHermanMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer Screening, Breast Cancer, Radiology, Breast Imaging Reporting And Data System (BI-RADS)
1
Answer |
5 months ago
As I understand it, if margins are positive, and there are cancer cells remaining, many surgeons will return to surgery to remove any positive margins. If this is not your scenario, then there are a number of options for imaging a mastectomy site; sonography and/or MRI are the most common. If you have a reconstructed breast, with either an implant, or TRAM-flap, a mammogram can be performed but this is not done routinely. Also physical exam is excellent, especially if the breast has not been reconstructed.
As I understand it, if margins are positive, and there are cancer cells remaining, many surgeons will return to surgery to remove any positive margins. If this is not your scenario, then there are a number of options for imaging a mastectomy site; sonography and/or MRI are the most common. If you have a reconstructed breast, with either an implant, or TRAM-flap, a mammogram can be performed but this is not done routinely. Also physical exam is excellent, especially if the breast has not been reconstructed.
New answer by ZevaHermanMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer Screening, Breast Cancer, Breast Cancer Screening Options
1
Answer |
5 months ago
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